PRIME CONSULTANT QUALIFICATION QUESTIONNAIRE - Download Now DOC

Document Sample
PRIME CONSULTANT QUALIFICATION QUESTIONNAIRE - Download Now DOC Powered By Docstoc
					                                                 PRIME CONSULTANT QUALIFICATION QUESTIONNAIRE

                             THE DETAILED DATA REQUESTED HERE MUST BE SUBMITTED IN THIS FORMAT ONLY.
                           USE AS MANY PAGES AS NEEDED TO PROVIDE THE FOLLOWING REQUIRED INFORMATION:
       PRIME CONSULTANT
A.     FIRM NAME: ______________________________________________________________________________________________________

       OFFICE LOCATION:_________________________________________________________________________________________________
                                                           Address
       CONTACT PERSON:__________________________________________________ TITLE: ______________________________________

       CONTACT PERSON E-MAIL:______________________________________________________

       TELEPHONE NUMBER:________________________ FAX NUMBER: ________________________ NO. OF EMPLOYEES __________

       The   undersigned intends to perform work in connection with the above project as (check one):
                     _____an individual         _____a corporation          _____a partnership _____a joint venture

B.     CERTIFIED DBE * : _______ YES                           _______ NO

* ATTACH APPLICABLE COPY OF NOTICE OF CERTIFICATION
__________________________________________________________________________________________________________________________________________________________________________________

C.     STAFF PERSONNEL (TO BE COMPLETED BY NON M/WBE FIRMS):
LIST ALL MINORITY/WOMEN PERSONNEL WHO WILL BE ASSIGNED TO THIS PROJECT BY STATING TITLE/RANK, EMPLOYMENT STATUS, AND THEIR PERCENTAGE
PARTICIPATION.
   JOB TITLE                   PART/FULL TIME                           MINORITY DESIGNATION                                PARTICIPATION %
1.
2.
3.
4.
_______________________________________________________________________________________________________________________________________

D.     1. PRIME’S “TOTAL PROJECT PARTICIPATION”                                        : .................................................................................. ….....   %
                                                                              (Note: If sub-consultants are included line 1 must be less than 100%)

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Project Name: ______________________________________________________


PALM BEACH METROPOLITAN PLANNNG ORGANIZATION                                                                              _____________________________________________
2300 N. JOG ROAD, 4TH FLOOR                                                                                                        CONSULTANT FIRM
WEST PALM BEACH, FL 33411
                                                                                                                                                                                     ___________
                                                                                                                                                        SIGNATURE

                                                                                                              ____________________________________________________
                                                                                                                                                               TITLE & DATE
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:8/8/2012
language:
pages:1